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Subarachnoid hemorrhage randomized

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https://www.readbyqxmd.com/read/29212462/pharmacological-targeting-of-secondary-brain-damage-following-ischemic-or-hemorrhagic-stroke-traumatic-brain-injury-and-bacterial-meningitis-a-systematic-review-and-meta-analysis
#1
Thomas Beez, Hans-Jakob Steiger, Nima Etminan
BACKGROUND: The effectiveness of pharmacological strategies exclusively targeting secondary brain damage (SBD) following ischemic stroke, aneurysmal subarachnoid hemorrhage, aSAH, intracerebral hemorrhage (ICH), traumatic brain injury (TBI) and bacterial meningitis is unclear. This meta-analysis studied the effect of SBD targeted treatment on clinical outcome across the pathological entities. METHODS: Randomized, controlled, double-blinded trials on aforementioned entities with 'death' as endpoint were identified...
December 7, 2017: BMC Neurology
https://www.readbyqxmd.com/read/29171362/complications-of-endovascular-treatment-for-acute-ischemic-stroke-prevention-and-management
#2
Joyce S Balami, Philip M White, Peter J McMeekin, Gary A Ford, Alastair M Buchan
Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29159600/early-seizure-prophylaxis-in-traumatic-brain-injuries-revisited-a-prospective-observational-study
#3
Desmond Khor, Jinglan Wu, Quanqiu Hong, Elizabeth Benjamin, Shuiming Xiao, Kenji Inaba, Demetrios Demetriades
INTRODUCTION: Pharmacological prophylaxis for early seizures following traumatic brain injury (TBI) is a recommendation in the Brain Trauma Foundation Guidelines. However, several studies have challenged the efficacy and safety of this practice, resulting in varied practice across centers around the world. The purpose of the present study was to compare the incidence of early clinical seizures following TBI, between two large centers, a US Center that practises routine seizure prophylaxis and a Chinese Center that does not use seizure prophylaxis following TBI...
November 20, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29158449/induced-hypertension-for-delayed-cerebral-ischemia-after-aneurysmal-subarachnoid-hemorrhage-a-randomized-clinical-trial
#4
Celine S Gathier, Walter M van den Bergh, Mathieu van der Jagt, Bon H Verweij, Jan Willem Dankbaar, Marcella C Müller, Annemarie W Oldenbeuving, Gabriel J E Rinkel, Arjen J C Slooter
BACKGROUND AND PURPOSE: Induced hypertension is widely used to treat delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage, but a literature review shows that its presumed effectiveness is based on uncontrolled case-series only. We here report clinical outcome of aneurysmal subarachnoid hemorrhage patients with DCI included in a randomized trial on the effectiveness of induced hypertension. METHODS: Aneurysmal subarachnoid hemorrhage patients with clinical symptoms of DCI were randomized to induced hypertension or no induced hypertension...
November 20, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29093065/low-dose-aspirin-and-risk-of-intracranial-bleeds-an-observational-study-in-uk-general-practice
#5
Lucía Cea Soriano, David Gaist, Montse Soriano-Gabarró, Susan Bromley, Luis A García Rodríguez
OBJECTIVE: To quantify the risk of intracranial bleeds (ICBs) associated with new use of prophylactic low-dose aspirin using a population-based primary care database in the United Kingdom. METHODS: A cohort of new users of low-dose aspirin (75-300 mg; n = 199,079) aged 40-84 years and a 1:1 matched cohort of nonusers of low-dose aspirin at baseline were followed (maximum 14 years, median 5.4 years) to identify incident cases of ICB, with validation by manual review of patient records or linkage to hospitalization data...
November 1, 2017: Neurology
https://www.readbyqxmd.com/read/29048544/valproic-acid-attenuates-the-risk-of-acute-respiratory-failure-in-patients-with-subarachnoid-hemorrhage
#6
Wen-I Liao, Wu-Chien Chien, Chi-Hsiang Chung, Jen-Chun Wang, Tzu-Tsao Chung, Shi-Jye Chu, Shih-Hung Tsai
Background: To determine whether the use of valproic acid (VPA) is associated with a decreased risk of acute respiratory failure (ARF) in patients with subarachnoid hemorrhage (SAH). Methods: The Taiwan National Health Insurance Research Database was used to analyze all patients newly diagnosed with SAH from 2000 to 2010. The VPA users were matched for age, gender and index date in 1:2 ratios with randomly selected non-VPA users as a comparison group. Multivariate Cox regression was used to identify the predictors of ARF and to compare the incidence rates of ARF among SAH patients using and not using VPA...
October 18, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29031080/endovascular-therapy-for-vasospasm-secondary-to-subarachnoid-hemorrhage-a-meta-analysis-and-systematic-review
#7
REVIEW
Zhong Yao, Xin Hu, Chao You
Endovascular therapy has been used as an alternative treatment for vasospasm following subarachnoid hemorrhage. The effectiveness and safety of endovascular therapy are still controversial. We performed a systematic review and meta-analysis to identify any advantage of endovascular therapy over traditional medical treatment. We systematically reviewed related English publications by searching PubMed, Ovid, Cochrane library, and Web of Science up to May 2017.The risk ratios (RR) and 95% confidence intervals (CI) were synthesized with fixed effect model...
December 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29021779/xenon-reduces-neuronal-hippocampal-damage-and-alters-the-pattern-of-microglial-activation-after-experimental-subarachnoid-hemorrhage-a-randomized-controlled-animal-trial
#8
Michael Veldeman, Mark Coburn, Rolf Rossaint, Hans Clusmann, Kay Nolte, Benedikt Kremer, Anke Höllig
OBJECTIVE: The neuroprotective properties of the noble gas xenon have already been demonstrated using a variety of injury models. Here, we examine for the first time xenon's possible effect in attenuating early brain injury (EBI) and its influence on posthemorrhagic microglial neuroinflammation in an in vivo rat model of subarachnoid hemorrhage (SAH). METHODS: Sprague-Dawley rats (n = 22) were randomly assigned to receive either Sham surgery (n = 9; divided into two groups) or SAH induction via endovascular perforation (n = 13, divided into two groups)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28989143/-protective-effect-of-mitochondria-targeted-antioxidant-ss31-on-early-brain-injury-following-subarachnoid-hemorrhage-in-rats
#9
Jian Zhou, Zhengzheng Li, Zhenggang Chen, Kun Yang
To evaluate protective effects of SS31 on early brain injury (EBI) induced by subarachnoid hemorrhage (SAH) in rats.
 Methods: A total of 96 Sprague-Dawley rats were randomly divided into 4 groups: A sham group, an SAH group, an SAH+vehicle group (SAH+V), and an SAH+SS31 group. The SAH-induced prechiasmatic cistern rat model was established in this study. Neurological deficit scores were evaluated at 24 h after SAH. The SS31 (5 mg/kg) as well as equal volume of vehicle were administrated intraperitoneally at 2 h after SAH...
September 28, 2017: Zhong Nan da Xue Xue Bao. Yi Xue Ban, Journal of Central South University. Medical Sciences
https://www.readbyqxmd.com/read/28987848/prevention-and-treatment-for-hyponatremia-in-patients-with-subarachnoid-hemorrhage-a-systematic-review
#10
REVIEW
Kieran Shah, Ricky Turgeon, Peter A Gooderham, Mary H H Ensom
BACKGROUND: Current guidelines have not systematically assessed the literature for the management of hyponatremia in patients with subarachnoid hemorrhage. OBJECTIVE: To evaluate the efficacy and safety of current preventative and treatment strategies of hyponatremia in patients with subarachnoid hemorrhage. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, MEDLINE, and PubMed for relevant studies. Primary outcomes of interest included neurological functional outcomes, symptomatic vasospasm, and others...
October 5, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28973585/characteristics-of-unruptured-compared-to-ruptured-intracranial-aneurysms-a-multicenter-case-control-study
#11
Isabel C Hostettler, Varinder S Alg, Nichole Shahi, Fatima Jichi, Stephen Bonner, Daniel Walsh, Diederik Bulters, Neil Kitchen, Martin M Brown, Henry Houlden, Joan Grieve, David J Werring
BACKGROUND: Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE: To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS: We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms...
July 25, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28966073/effect-of-simvastatin-in-patients-with-aneurysmal-subarachnoid-hemorrhage-a-systematic-review-and-meta-analysis
#12
REVIEW
Hongju Liu, Xiaoli Xu
BACKGROUND: Simvastatin might be beneficial to the patients with aneurysmal subarachnoid hemorrhage. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of simvastatin for aneurysmal subarachnoid hemorrhage. METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of simvastatin versus placebo on aneurysmal subarachnoid hemorrhage were included...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28945859/high-dose-nadroparin-following-endovascular-aneurysm-treatment-benefits-outcome-after-aneurysmal-subarachnoid-hemorrhage
#13
Rene Post, IJsbrand A J Zijlstra, Rene van den Berg, Bert A Coert, Dagmar Verbaan, W Peter Vandertop
BACKGROUND: Delayed cerebral ischemia (DCI) is one of the major causes of delayed morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: To evaluate the effect of high-dose nadroparin treatment following endovascular aneurysm treatment on the occurrence of DCI and clinical outcome. METHODS: Medical records of 158 adult patients with an aSAH were retrospectively analyzed. Those patients treated endovascularly for their ruptured aneurysm were included in this study...
July 27, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28886745/bayesian-dose-selection-design-for-a-binary-outcome-using-restricted-response-adaptive-randomization
#14
Caitlyn Meinzer, Renee Martin, Jose I Suarez
BACKGROUND: In phase II trials, the most efficacious dose is usually not known. Moreover, given limited resources, it is difficult to robustly identify a dose while also testing for a signal of efficacy that would support a phase III trial. Recent designs have sought to be more efficient by exploring multiple doses through the use of adaptive strategies. However, the added flexibility may potentially increase the risk of making incorrect assumptions and reduce the total amount of information available across the dose range as a function of imbalanced sample size...
September 8, 2017: Trials
https://www.readbyqxmd.com/read/28862545/sex-differences-in-delayed-cerebral-ischemia-after-subarachnoid-hemorrhage
#15
Menno R Germans, Blessing N R Jaja, Airton Leonardo de Oliviera Manoel, Ashley H Cohen, R Loch Macdonald
OBJECTIVE In this study the authors sought to investigate the sex differences in the risk of delayed cerebral ischemia (DCI), delayed cerebral infarction, and the role of hormonal status. METHODS Ten studies included in the SAHIT (SAH International Trialists) repository were analyzed using a fitting logistic regression model. Heterogeneity between the studies was tested using I(2) statistics, and the results were pooled using a random-effects model. Multivariable analysis was adjusted for the effects of neurological status and fixed effect of study...
September 1, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28831717/a-randomized-trial-of-brief-versus-extended-seizure-prophylaxis-after-aneurysmal-subarachnoid-hemorrhage
#16
Theresa Human, Michael N Diringer, Michelle Allen, Gregory J Zipfel, Michael Chicoine, Ralph Dacey, Rajat Dhar
BACKGROUND: Seizures occur in 10-20% of patients with subarachnoid hemorrhage (SAH), predominantly in the acute phase. However, anticonvulsant prophylaxis remains controversial, with studies suggesting a brief course may be adequate and longer exposure may be associated with worse outcomes. Nonetheless, in the absence of controlled trials to inform practice, patients continue to receive variable chemoprophylaxis. The objective of this study was to compare brief versus extended seizure prophylaxis after aneurysmal SAH...
August 22, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28821992/analysis-of-outcome-at-discharge-after-aneurysmal-subarachnoid-hemorrhage-in-japan-according-to-the-japanese-stroke-databank
#17
Fusao Ikawa, Masaru Abiko, Daizo Ishii, Jyunpei Ohshita, Toshinori Matsushige, Takahito Okazaki, Shigeyuki Sakamoto, Eisuke Hida, Shotai Kobayashi, Kaoru Kurisu
The outcomes at discharge for ruptured cerebral aneurysms after subarachnoid hemorrhage (SAH) were investigated using data from the Japanese stroke databank. Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients had SAH caused by ruptured saccular aneurysm. Of these, 3593 patients (1140 men and 2453 women; mean age 61.3 ± 13.7 years) were treated by surgical clipping (SC) and/or endovascular coiling (EC). The outcomes of modified Rankin scale (mRS) at discharge were compared between the SC and EC groups...
August 19, 2017: Neurosurgical Review
https://www.readbyqxmd.com/read/28808649/the-effect-of-a-single-dose-dantrolene-in-patients-with-vasospasm-following-aneurysmal-subarachnoid-hemorrhage
#18
Masih Sabouri, Mahmood Momeni, Fariborz Khorvash, Majid Rezvani, Homayon Tabesh
BACKGROUND: Cerebral vasospasm is a prolonged, occasionally severe, but reversible narrowing of the cerebral arteries that begins 3 to 5 days after the hemorrhage becomes maximal at 14 days. This study is designed to evaluate the effect of dantrolene on the reduction of vasospasm following aneurysmal subarachnoid hemorrhage (SAH). MATERIALS AND METHODS: This randomized controlled clinical trial was conducted on 32 patients with proven aneurysms in AL-Zahra hospital during 2011-2013...
2017: Advanced Biomedical Research
https://www.readbyqxmd.com/read/28762878/long-acting-statin-for-aneurysmal-subarachnoid-hemorrhage-a-randomized-double-blind-placebo-controlled-trial
#19
Masato Naraoka, Naoya Matsuda, Norihito Shimamura, Kenichiro Asano, Kenichi Akasaka, Atsuhito Takemura, Seiko Hasegawa, Hiroki Ohkuma
Statins have pleiotropic effects that are considered beneficial in preventing cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage (aSAH). Many studies using statins have been performed but failed to show remarkable effects. We hypothesized that a long-acting statin would be more effective, due to a longer half-life and stronger pleiotropic effects. Patients with aSAH were randomly assigned to a pitavastatin group (4 mg daily; n = 54) and a placebo group ( n = 54) after repair of a ruptured aneurysm...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28698029/critical-role-of-epha4-in-early-brain-injury-after-subarachnoid-hemorrhage-in-rat
#20
Ruiming Fan, Budbazar Enkhjargal, Richard Camara, Feng Yan, Lei Gong, ShengtaoYao, Jiping Tang, Yangmei Chen, John H Zhang
Early brain injury (EBI) is reported as a primary cause of mortality in subarachnoid hemorrhage (SAH) patients. Eph receptor A4 (EphA4) has been associated with blood-brain barrier integrity and pro-apoptosis. We aimed to investigate a role of EphA4 in EBI after SAH. One hundred and seventy-nine male adult Sprague-Dawley rats were randomly divided into sham versus endovascular perforation model of SAH groups. SAH grade, neurological score, Evans blue dye extravasation, brain water content, mortality, Fluoro-Jade staining, immunofluorescence staining, and western blot experiments were performed after SAH...
October 2017: Experimental Neurology
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